(1) Field of the Invention
The invention generally relates to means and methods of closing wounds of humans and other mammals. More particularly, the invention relates to a technique of applying a suture to close a wound in tension, especially a wound in thick skin, such as scalp or back wound
(2) Description of the Related Art
Several techniques and devices that attempt to close skin wounds under tension are known in the art. For example, U.S. Pat. No. 6,471,715 Suture tightening device for closing wounds and methods for its use by Weiss, issued on Oct. 29, 2002 discloses a suture tightening wound closure device that includes the use of plates on either side of a wound and skin piercing stickers under the plates and other cumbersome, damaging and expensive mechanical parts. The device and technique of Weiss lead to an excessive amount of skin penetrations. The device used by Weiss to thread and/or install the plates is unduly complex and makes bandaging the wound difficult.
U.S. Pat. No. 5,127,412 Skin tensioning by Cosmetto et al, issued on Jul. 7, 1992 discloses a skin tensioning kit that resembles a mechanical pulley system with a bulky winder wheel assembly that stays attached to the wound victim. The winder of Cosmetto causes the suture or thread material to be tightened and secured at an elevation above the skin surface. The raised suture system of Cosmetto applies an upward ripping pressure on the skin where the sutures first penetrate the skin near each plate.
Other methods to assist in the closure of wounds under tension include: utilizing a layered closure, tissue expanders, an assistant or second pair of hands to push the wound edges together, Pulley stitch or Far-near-near-far suture, Winch stitch, towel clamps, horizontal mattress suture, and multiple relaxing skin incisions. These other methods and/or devices have numerous shortfalls and risks.
The use of tissue-expanding devices such as the sure-closure device and the Frechet extender is costly and may also place a mechanical load on or in the skin as the two sides of a wound are stretched together. An assistant's extra hands within the confines of a wound area may be awkward and a qualified assistant may not always be available. The far-near-near-far technique may result in unsightly scar tissue or cosmetic imperfections due to tension on the epidermis. A towel clamp is not suitable for areas of thin skin such as the face, as the towel clamp may cause the skin to tear. Multiple relaxing skin incisions cause trauma to the skin surrounding the wound area and a risk of scarring.
The horizontal mattress suture presents a risk of compromise to the blood supply to the wound area. Due to this risk factor, bolsters are sometimes used if the horizontal mattress suture is to be left in for additional support.
Despite advances of the related art, the primary repair of high-tension defects or skin wounds under tension is still difficult, risky, time consuming and expensive. Thus, there is a need in the art for additional means of wound closure.